Application of a Beta-Tricalcium Phosphate Graft to Minimize Bony Defect in Bone– Patella Tendon–Bone Anterior Cruciate Ligament Reconstruction Avinesh.

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Application of a Beta-Tricalcium Phosphate Graft to Minimize Bony Defect in Bone– Patella Tendon–Bone Anterior Cruciate Ligament Reconstruction Avinesh Agarwalla, B.S., Richard Puzzitiello, B.S., Grant H. Garcia, M.D., Brian Forsythe, M.D. Arthroscopy Techniques Volume 7, Issue 7, Pages e725-e729 (July 2018) DOI: 10.1016/j.eats.2018.03.009 Copyright © 2018 Arthroscopy Association of North America Terms and Conditions

Fig 1 Right knee in 10° of flexion. Gross image of the distal insertion of the patellar tendon into the tibial tubercle. An osteotome is used to remove the bone blocks for the bone–patellar tendon–bone autograft that is to be used in the anterior cruciate ligament reconstruction portion of the procedure. Arthroscopy Techniques 2018 7, e725-e729DOI: (10.1016/j.eats.2018.03.009) Copyright © 2018 Arthroscopy Association of North America Terms and Conditions

Fig 2 Right knee in 10° of flexion. Gross image of the proximal insertion of the patellar tendon into the distal pole of the patella. An unshaped wedge of 10-mm-thick beta-tricalcium phosphate (β-TCP) is placed within the bony defect to approximate the amount of graft that must be removed to allow for a proper fit. Arthroscopy Techniques 2018 7, e725-e729DOI: (10.1016/j.eats.2018.03.009) Copyright © 2018 Arthroscopy Association of North America Terms and Conditions

Fig 3 (A) Right knee in 10° of flexion. Gross image of the beta-tricalcium phosphate (β-TCP) being trimmed in length for proper sizing within the bony defect. (B) Right knee in 10° of flexion. Gross image of the β-TCP being trimmed in width for proper sizing within the bony defect. Arthroscopy Techniques 2018 7, e725-e729DOI: (10.1016/j.eats.2018.03.009) Copyright © 2018 Arthroscopy Association of North America Terms and Conditions

Fig 4 Right knee in 10° of flexion. Gross image of the proximal insertion of the patellar tendon into the distal pole of the patella. The beta-tricalcium phosphate (β-TCP) graft is impacted into the bony defect with a mallet and tamp to create a press fit. Arthroscopy Techniques 2018 7, e725-e729DOI: (10.1016/j.eats.2018.03.009) Copyright © 2018 Arthroscopy Association of North America Terms and Conditions

Fig 5 Right knee in 10° of flexion. Gross image of the proximal insertion of the patellar tendon into the distal pole of the patella. A 0-Vicryl absorbable suture is used to close the periosteum over top of the graft, thus securing it in place. (β-TCP, beta-tricalcium phosphate.) Arthroscopy Techniques 2018 7, e725-e729DOI: (10.1016/j.eats.2018.03.009) Copyright © 2018 Arthroscopy Association of North America Terms and Conditions

Fig 6 Right knee in 10° of flexion. Gross image of the proximal insertion of the patellar tendon into the distal pole of the patella. A 0-Vicryl absorbable suture is used to close the paratenon over top of the graft after closure of the periosteum. Arthroscopy Techniques 2018 7, e725-e729DOI: (10.1016/j.eats.2018.03.009) Copyright © 2018 Arthroscopy Association of North America Terms and Conditions